This is the specialized care required for a colostomy. For some medical
problems involving the large intestine, also known as the colon, a new passage
must be created to allow stool to leave the body. An opening in the abdominal
wall is created by a surgeon. The surgeon connects the colon to the outside
abdominal wall of the body. This is called a colostomy.
The opening in the abdomen on the outside of the body is called a stoma.
Who is a candidate for the procedure?
A person may need a colostomy if he or she has had an
infection, inflammation, or blockage in the bowel. The colostomy may
also be part of treatment for colon cancer.
Bowel defects or injuries might also result in a colostomy. The underlying
condition that leads to a colostomy will affect a person's emotional,
psychological, and physical recovery from surgery. A colostomy may be
temporary or permanent.
How is the procedure performed?
Colostomy education begins before surgery. Diagrams,
photographs, and examples of equipment are used to help to explain
what the person might expect after surgery. Concerns about upcoming
changes in body image, lifestyle, and sexuality are also addressed.
When a person has a colostomy, a team of healthcare
professionals provides education and initial care. These may include a doctor,
nurse, social worker, and dietitian. An enterostomal therapist, known as an ET,
might also help with care. ETs are usually registered nurses who have had
specialized training and certification in the care of ostomies and wounds.
People with colostomies are given information and training specific to their needs.
Ongoing care may often extend well beyond the initial hospital stay.
The colostomy will begin to function 3 to 6 days after surgery.
At first, a nurse or ET will take care of the colostomy.
This person will also teach the person how to care for the colostomy on
his or her own. Gradually, the individual will be able to take over the care
of the stoma and the skin around the stoma.
The stoma is red and shaped in an oval. It resembles the skin
on the inside of the lower lip. A drainage bag or pouch is attached to the
skin around the stoma. The stool drains into this pouch. The stoma size
determines the size of the pouch. The size of the stoma may vary at first
due to swelling and weight fluctuation. The stoma is often checked 3 weeks
after surgery, when swelling has subsided. The final size and type of pouch
used will be set about 3 months after the colostomy. This is when a person's
weight and size are likely to be stable again.
There are many types of pouches available. Most pouches are
odor-resistant and disposable. The nurse or ET can help
the person choose an appliance that fits well. Good skin care around the
stoma is critical. Before applying a fresh pouch, the skin around the stoma
is washed gently with a mild soap. A gauze dressing may be used to cover
the stoma while the skin is cleaned. The skin is patted completely dry with
a gauze pad. Rubbing should be avoided. A healthcare provider may suggest
using nystatin powder on the skin around the stoma to combat irritation or
yeast growth. A skin barrier, which may be a wafer or paste, is then applied
to protect the skin from bowel contents draining through the stoma. The
backing of the adhesive surface of the pouch is removed. The bag is then
pressed down around the stoma for 30 seconds. The pouch should be removed
and drained when it is one-third to one-fourth full. If the pouch becomes
too full, the weight could cause the bag to come off and spill.
Colostomy irrigation, a procedure in which fluid is inserted into
the bowel through the stoma, might be used to regulate the passage of stool.
This helps avoid constipation.
The healthcare provider will advise when and how to perform irrigation.
A dietitian can help a person with a colostomy choose a balanced
diet. It may be helpful to avoid some foods, such as those that cause gas and
odor. These foods include:
members of the cabbage family
Foods or fluids such as fruits, coffee, carbonated
beverages, or high-fiber items may cause diarrhea. Foods with hard-to-digest
kernels, such as popcorn, may need to be avoided as well. Nonirritating foods
can be substituted for those that must be restricted.